Intrapericardial assist device and associated method

ABSTRACT

A surgical method for assisting a malfunctioning heart comprises inserting a balloon into an intrapericardial space and inflating the balloon in the intrapericardial space to place a compressive pressure on a heart in the intrapericardial space sufficient to force blood from the heart. A lubricant is fed to the intrapericardial space after insertion of the balloon into the space.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of application Ser. No.08/286,817 filed Aug. 5, 1994, now U.S. Pat. No. 5,533,958, which wasfiled as a continuation-in-part of application Ser. No. 08/078,567 filedJun. 17, 1993, now U.S. Pat. No. 5,385,528.

BACKGROUND OF THE INVENTION

This invention relates to an intrapericardial assist device. Thisinvention also relates to an associated surgical method for starting astopped heart or restarting a heart with a pronounced arrythmia.

When a patient's heart stops, for example, in the operating room,cardiopulmonary resuscitation (CPR) is required. In that procedure thechest is violently pounded at the region of the sternum to compress thechest and thereby compress the heart between the sternum and the spine.This compression forces blood out of the ventricles through the one-wayvalves of the heart. When the pressure on the heart is released, theheart expands and blood is sucked into the heart.

For all its violence, CPR is a delicate procedure in that it must beperformed correctly in order to have the desired result of starting thestopped heart. A problem with CPR is that, whether or not it isperformed correctly, CPR invariably results in cracked ribs, a fracturedsternum and destroyed costo-chondral (cartilage) junctions. Thus even ifa patient survives CPR, he is usually injured.

It is known to insert a needle into the intrapericardial space aroundthe heart. This procedure is frequently undertaken to obtain a sample offluid (e.g., blood) in the intrapericardial space. An electrical sensorat the tip of the needle senses when the surface of the heart has beenreached and alerts the doctor to cease pushing on the needle.

OBJECTS OF THE INVENTION

An object of the invention is to provide a method and/or an associateddevice for resuscitating a stopped heart.

A more particular object of the invention is to provide such a methodwherein the excessive trauma characteristic of conventional CPR islargely, if not completely, obviated.

Another object of the invention is to provide such a method which iseasy and quick to use.

Another, more particular, object of the invention is to provide such amethod which may be implemented at least partially automatically,thereby reducing the exertion required by the resuscitating personnel.

Yet another object of the invention is to provide a method forintroducing or instilling a regular heart beat into a heart which has apronounced and potentially fatal arrythmia.

A further particular object of the invention is to provide a device forcardiopulmonary resuscitation and/or for regularizing a heart beat.

These and other objects of the invention will be apparent from thedrawings and detailed descriptions herein.

BRIEF DESCRIPTION

A surgical method for aiding a malfunctioning heart utilizes, inaccordance with one embodiment of the present invention, an inflatableballoon in a collapsed configuration. The balloon is inserted into anintrapericardial space about a heart disposed in the space.Subsequently, the balloon is inflated in the intrapericardial space toplace a compressive pressure on the heart sufficient to force blood fromthe heart. In addition, a lubricant is fed to the intrapericardial spaceafter insertion of the balloon into the space.

Preferably, lubricant is fed to the intrapericardial space by drippingthe lubricant via gravity flow. The lubricant facilitates multiplecycles of balloon expansion by reducing friction with the pericardialwall. The lubricant may be a saline solution with cortico-steroids to atleast reduce adhesion formation. The balloon is made of a flexiblematerial with a low coefficient of friction such as GORTEX_(tm).

Where a pair of tubes are operatively connected to the balloon, theinflating of the ballooon includes guiding a fluid under pressure to theballoon via one tube, while the feeding of the lubricant to theintrapericardial space including guiding the lubricant to theintrapericardial space via another tube.

The inserting of the balloon into the intrapericardial space isaccomplishable via a hypodermic type needle which is inserted through askin surface and into the intrapericardial space. The balloon isinjected in the collapsed configuration into the intrapericardial space.

Generally, it is contemplated that the balloon is periodically inflatedand collapsed after insertion into the intrapericardial space.

The balloon may be provided with an electrode on a surface adapted forcontact with the heart. In that case, the method further comprisesconducting a voltage through the electrode to the heart after inflationof the balloon. Where the voltage is a defibrillating voltage, themethod further comprises monitoring heart action via an EKG device for apredetermined period upon completion of the step of conducting and, upona determination that the heart has started with an inadequate strength,inflating the balloon in synchronism with a heart contraction to place acompressive pressure on the heart to thereby increase pumping action.

Alternatively, a pacemaker type periodic voltage may be generated andapplied to the heart via the electrode. The balloon is maintained in aninflated state during application of the periodic voltage to the heartto maintain the electrode in electrically conductive contact with theheart of the patient.

An intrapericardial assist device comprises, in accordance with anembodiment of the present invention, a balloon having a predeterminedsize and shape in an expanded configuration so that the balloon iscapable of being disposed in an intrapericardial space about a heart. Aninflation component is operatively connected to the balloon forinflating the balloon from an unfolded collapsed configuration to theexpanded configuration. Also, a lubricating element such as a feed ordrip tube is operatively connected to the balloon for delivering alubricant to an external surface of the balloon upon disposition of theballoon in the intrapericardial space.

A spring such as an elongate rib element may be connected to the balloonfor automatically unfurling the balloon from a folded collapsedconfiguration to an unfolded collapsed configuration.

Preferably, the inflation component includes means for automatically andperiodically inflating and alternately deflating the balloon upon adisposition thereof into the intrapericardial space.

An electrical contact may be disposed on a surface of the balloon forconducting electrical energy to the heart upon an insertion of theballoon into the intrapericardial space. In that event, circuitry isoperatively connected to the contact for supplying electrical energy tothe contact.

A surgical method for assisting a malfunctioning heart comprises, inaccordance with a general conceptualization of the invention, insertinga balloon into an intrapericardial space, and inflating the balloon inthe intrapericardial space to place a compressive pressure on a heart inthe intrapericardial space sufficient to force blood from the heart.Generally, the balloon is periodically inflated after insertion thereofinto the pericardial space.

A method in accordance with the invention solves the problem of thetrauma and injury inflicted upon a patient during conventional CPR. Ribsand sternum remain intact.

A method and apparatus in accordance with the invention serve in part tointroduce a regular heart beat into a heart which has a pronounced andpotentially fatal arrythmia. Pursuant to the invention, upon insertionof the electrode-carrying balloon into the intrapericardial space, thearrythmic heart is shocked by a defibrillating voltage into exhibiting amore regular heart beat. The balloon is then used to assist the heartduring initial stages of its newly regular action. A pacemaker voltageis subsequently applied to the restarted heart for extending the regularaction of the heart.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a partially a schematic perspective view, on a reduced scale,and partially a block diagram of an intrapericardial assist orresuscitation assembly in accordance with the invention, showing aninflatable intrapericardial cuff in an expanded configuration.

FIG. 2 is a schematic cross-sectional view of the inflatableintrapericardial cuff of FIG. 1.

FIG. 3 is a schematic transverse cross-sectional view of the inflatableintrapericardial cuff of FIGS. 1 and 2 in a folded, collapsedpre-insertion configuration inside a hypodermic type needle.

FIG. 4 is a schematic longitudinal cross-sectional view of theinflatable intrapericardial cuff of FIGS. 1-3 in the folded, collapsedpre-insertion configuration inside the hypodermic needle of FIG. 3.

FIG. 5 is a perspective view of the cuff of FIGS. 1-4 in an expandedconfiguration in place inside an intrapericardial space.

FIG. 6 is another schematic perspective view of an inflatableintrapericardial cuff in accordance with the invention, showing memoryribs inside the cuff for aiding in an unfolding thereof upon insertionof the cuff into an intrapericardial space.

FIGS. 7A-7C are schematic perspective views showing successive steps inone intrapericardial cuff insertion procedure in accordance with theinvention.

FIG. 8 is partially a schematic perspective view, on a reduced scale,and partially a block diagram of a modified intrapericardial assist orresuscitation assembly in accordance with the invention, showing anexpanded intrapericardial cuff with a voltage source operativelyconnected to an electrode array along an inner surface of the cuff.

FIG. 9 is a block diagram showing details of the voltage sourceillustrated in FIG. 8.

FIG. 10 is partially a schematic perspective view, on a reduced scale,and partially a block diagram of a modified intrapericardial assist orresuscitation assembly in accordance with the invention, showing anexpanded intrapericardial cuff with a lubricant source operativelyconnected to the cuff.

DETAILED DESCRIPTION

As illustrated in FIG. 1, an intrapericardial assist or resuscitationassembly comprises an alternately inflatable and collapsible balloon 12in the form of a cuff. Cuff 12 has an elongate tube 14 extending to avalve device 16 which is connected to a suction source or vacuumgenerator 18 and to a source 20 of pressurized fluid such as water,saline solution or a gas such as air. In response to signals from acontrol unit 22, valve device 16 periodically connects cuff 12 topressure source 20 and alternately to suction source 18, whereby cuff 12is rapidly and forcefully inflated with a predetermined periodicity.

Control unit 22 may be provided with setting knobs (not illustrated) forvarying the rate and maximum pressure that is applied to the cuff uponproper disposition thereof in the intrapericardial space about theheart.

As illustrated in FIGS. 1 and 2, cuff 12 has an arcuate, generallyC-shaped configuration in its expanded or inflated state. Cuff 12 has apair of major C-shaped walls 24 and 26 defining a pressurization chamber28. Embedded in walls 24 and 26 are spring elements or ribs 30 and 32which can be bent into a curled configuration (see FIG. 3) but whichtend to resume their C-shaped expanded configurations when cuff 12 isplaced into an intrapericardial space during a cardiopulmonaryresuscitation procedure.

As illustrated in FIGS. 3 and 4, prior to a cardiopulmonaryresuscitation procedure, cuff 12 is folded and inserted in a collapsedconfiguration inside a hollow hypodermic type needle 34. Needle 34 isprovided at a distal end 36 with an aperture 38 for the ejection offolded and collapsed cuff 12 by a distally directed stroke of a plungermember 40 upon a disposition of distal end 36 into an intrapericardialspace during a cardiopulmonary resuscitation procedure. Distal end 36 isalso provided with an electrical sensor for detecting the surface of theheart, as is conventional in known intrapericardial sampling needles.

Distal end 36 of intrapericardial needle 34 is inserted into theintrapericardial space through the skin under the patient sternum.

FIG. 5 shows the placement of cuff 12 in an intrapericardial spacebetween a heart HT and the associated surrounding parietal pericardiumPP. The diagram also shows the superior vena cava SVC, the pulmonaryartery PA, the ascending aorta AA, and other veins and arteries.

As depicted in FIG. 6, an inflatable intrapericardial cuff 42 may beprovided with a plurality of longitudinally extending ribs 44 and aplurality of transversely extending expansion ribs 46. Each rib 46 has amemory whereby the rib may be bent for insertion and retrieval from apatient's intrapericardial space, but tends to assume a pre-establishedconfiguration (FIG. 6) upon insertion of the cuff 42 into anintrapericardial space or cavity.

In another cuff insertion procedure depicted in FIGS. 7A-7C, a sharpdistal tip 48 of an intrapericardial needle 50 is inserted through apatient's skin SS under the sternum ST. A dilating device 52 comprisinga plurality of longitudinal ribs 54 interconnected by stretchablemembranes 56 surrounds needle 50 during the insertion procedure. Uponthe insertion of distal tip 48 into the intrapericardial cavity at thepatient's heart, dilating device is slid in the distal direction so thata distal end portion thereof is disposed or inserted into theintrapericardial cavity. Needle 50 is then removed, as shown in FIG. 7B.

Upon the removal of needle 50 from the patient, leaving dilating device52 partially inserted into the patient's intrapericardial cavity, thedilating device may be expanded, for example, by the insertion of aseries of increasing large elongate rigid dilators (not shown). Then,cuff 12 or 42 is inserted in a folded collapsed collapsed configurationinto the intrapericardial cavity through the expanded dilating device52, as shown in FIG. 7C. An inserter (not illustrated) may be used forpushing the cuff through dilating device 52.

The general use and structure of dilating device 52 is described indetail in allowed U.S. patent application Ser. No. 851,097 filed Mar.13, 1992 and U.S. patent application Ser. No. 893,991 filed Jun. 5,1992. The disclosures of those applications are hereby incorporated byreference.

As depicted in FIG. 8, an intrapericardial assist device comprises anelectrode carrier in the form of an inflatable balloon 60 adapted forjuxtaposition to a patient's heart in an intrapericardial space, asdiscussed hereinabove with reference to FIG. 5. The electrode-carryingballoon 60 has an inwardly facing surface 62 adapted for contact withthe patient's heart. An array of electrical contacts or electrode wires64 is disposed on contact surface 62 of balloon 60 for conductingelectrical energy to the patient's heart upon an insertion of balloon 60into the intrapericardial space. Current transmission elements or leads66 are operatively connected to electrical contacts 64 for deliveringelectrical energy thereto from a voltage source 68. A hose 70 extends toballoon 60 for maintaining the balloon in an inflated state and therebymaintaining the balloon's contact surface 62 in adequate engagement withthe patient's heart during the application of electrical energy to theheart via voltage source 68, transmission leads 66 and electricalcontacts or electrodes 64.

Balloon 60 is a collapsible member with a configuration of a slottedcuff in an expanded configuration. Balloon 60 has a predetermined sizeand shape in the expanded configuration so that it is disposable in theintrapericardial space in juxtaposition to the patient's heart.Preferably, one or more spring elements in the form of elongate ribs,e.g. 30, 32 (FIG. 2) or 44, 46 (FIG. 6), are connected to balloon 60 forautomatically unfurling the balloon from a folded collapsed insertionconfiguration to an expanded use configuration.

The means for maintaining contact surface 62 of balloon 60 in engagementwith the patient's heart during a cardiac jump start as described hereinincludes inflation componentry 72 operatively connected to balloon 60via hose 70. Inflation componentry 72 includes a valve device 74 whichis connected to a suction source or vacuum generator 76 and to a source78 of pressurized fluid such as water, saline solution or a gas such asair or carbon dioxide. In response to signals from a control unit 80such as a specially programmed microprocessor, pressure source 78 andvalve device 74 pressurize balloon 60 to a predetermined pressure duringan electrical cardiac stimulation procedure, whereby contacts orelectrodes 64 are maintained in electrically conductive contact with apatient's heart. Alternatively, during mechanical heart stimulation asdescribed herein, control unit 80 activates valve device 74 toperiodically connect balloon 60 to pressure source 78 and alternately tosuction source 76, whereby balloon 60 is rapidly and forcefully inflatedwith a predetermined periodicity.

Control unit 80 is provided with setting knobs 82 for enabling apreselection of an inflation pressure of balloon 60 and for varying therate and maximum pressure that is applied to balloon 60 upon properdisposition thereof in the intrapericardial space about the heart.

As further depicted in FIG. 8, a plurality of sensor electrodes 84 isdisposed on contact surface 62 of balloon 60 for monitoring naturalvoltages of a cardiac cycle. Sensor electrodes 84 are connected to EKGprocessing circuitry 86 via leads 88. According to conventional signalprocessing techniques, circuitry 86 generates a signal indicative of thepatient's heart activity and displays the signal via a cathode ray tube(CRT) or video screen 90. Sensor electodes 84 and EKG processingcircuitry facilitate the monitoring of heart activity during a heartresuscitation or beat regularization procedure as described below.

In a surgical method for reactivating a malfunctioning heart, e.g., astopped heart or a dangerously arrythmic heart, balloon 60 is insertedinto an intrapericardial space about the patient's heart, as discussedabove with reference to FIGS. 5 and 7A-7C. Upon deployment of balloon 60in the intrapericardial space, the balloon is inflated to placeelectrodes 64 in electrically conductive contact with the heart. Then, adefibrillating type voltage produced by a generator 92 of voltage source68 is conducted via leads 66 and electrodes 64 to the patient's heart.

Upon the conduction of the defibrillating type voltage to the patient'sheart, heart action is monitored via electrodes 84, processing circuitry86 and CRT 90 for a predetermined period. If it is determined at thatjuncture that the patient's heart has started but with an insufficientlystrong action, input provided to control unit 80 via setting knobs 82induces that unit to control valve device 74 so as to inflate balloon 60forcefully in synchronism with a heart contraction. Synchronism may beachieved, for instance, by providing control unit 80 with input from ablood pressure and pulse sensor 94 (including, e.g., a separate pressurecuff). Alternatively, if balloon 60 is sufficiently inflated, controlunit 80 may receive input from EKG processing circuitry 86. In eithercase, control unit or microprocessor 80 determines when a heartcontraction is about to occur and opens valve device 74 to induce a flowof pressurizing fluid along hose 70 to balloon 60. The placement of acompressive pressure on the heart to thereby increase pumping action mayalternatively be initiated manually by providing a triggering signal tocontrol unit 80 via setting knobs or input 82.

Balloon 60 may be at least partially deflated upon conduction of thedefibrillating type voltage to the heart and prior to the monitoring ofthe heart action. The deflation may be only partial in the event thatthe heart action is monitored via sensor electrodes 84 and EKGprocessing circuitry 86. The deflation may be greater where the cardiacactivity is determined via a conventional EKG device separate fromballoon 60 and electrodes 84.

To further instill a regular heart beat, a pacemaker type periodicvoltage is produced by a generator 96 included, together with generator92, in voltage source 68. The pacemaker type voltage is applied to thepatient's heart via contacts or electrodes 64 upon an inflation ofballoon 60 sufficient to ensure electrically conductive engagementbetween the heart tissues and the electrodes. Control unit 80 regulatesthe pressurization of balloon 60 via valve device 74 and pressure source78.

The pacemaker type voltage may be applied after a defibrillatingprocedure as described hereinabove and after periodic cuff inflation tostrengthen the heart beat. Control unit 80 determines by the activationof a switch 98 (FIG. 9) whether a defibrillating type voltage or apacemaker voltage is applied to the cardiac tissues.

As described hereinabove with reference to FIGS. 7A-7C, the insertion ofballoon 60 into the intrapericardial space may be implemented usinghypodermic type needle 34. Needle 34 is inserted through a skin surfaceand into the intrapericardial space, balloon 60 being injected in thecollapsed configuration through the needle into the intrapericardialspace. As further discussed hereinabove with reference to FIGS. 7A-7C,dilating device 52 may be provided for facilitating the insertion ofballoon 60 into the intrapericardial space. Needle 50 is partiallyinserted through the skin surface and into the intrapericardial spaceand a distal end portion of dilating device 52 is placed into theintrapericardial space via the needle upon the partial insertion thereofinto the intrapericardial space. Dilating device 52 is subsequentlyexpanded and balloon 60 inserted into the intrapericardial space throughthe expanded dilating device.

As illustrated in FIG. 10, a modified intrapericardial assist device 100comprises a balloon 102 having a predetermined size and shape in anexpanded configuration so that the balloon is capable of being disposedin an intrapericardial space about a heart. Inflation componentryincluding a tubular member 104 and a reversible pump 106 is operativelyconnected to balloon 102 for inflating the balloon from an unfoldedcollapsed insertion configuration to the expanded configuration. Also, afeed or drip tube 108 is operatively connected to balloon 102 fordelivering a lubricant 110 from a reservoir 112 to an external surface114 of balloon 102 upon disposition of the balloon in theintrapericardial space. A manifold 116 may be provided in or alongballoon 102 for delivering the lubricant 110 to a plurality of aperturesor outlets 118 along surface 114. Lubricant 110 may take the form of asaline solution provided with corticosteroids for inhibiting or evenpreventing the formation of adhesions in the pericardial space.

The lubricating componentry of FIG. 10 may be incorporated into any ofthe embodiments discussed above. Conversely, componentry from the aboveembodiments may be added to the embodiment of FIG. 10. For example,assist device 100 may include, as shown in FIG. 2, spring elements orribs 30 and 32 which can be bent into a curled configuration (see FIG.3) but which tend to resume their C-shaped expanded configurations whencuff 12 is placed into an intrapericardial space during acardiopulmonary resuscitation procedure. Spring elements or ribs 30 and32 (FIG. 2) automatically unfurl balloon 102 (FIG. 10) from a foldedcollapsed configuration to an unfolded collapsed configuration.

Reversible pump 106 automatically and periodically inflates andalternately deflates balloon 102 upon a disposition thereof into theintrapericardial space. Pump 106 may include the elements illustrated inFIG. 1, namely, control unit 22, valves 16, suction source 18 andpressure source 20.

As discussed above with reference to FIG. 8, an array of electricalcontacts or electrode wires 64 (FIG. 8) may be disposed on an innercontact surface 120 of balloon 102 (FIG. 10) for conducting electricalenergy to the patient's heart upon an insertion of balloon 102 into theintrapericardial space. The delivery of lubricant 110 (FIG. 10) to theintrapericardial space is useful in the embodiment of FIG. 8, where ahose 70 extends to balloon 60 for maintaining the balloon in an inflatedstate and thereby maintaining the balloon's contact surface 62 inadequate engagement with the patient's heart during the application ofelectrical energy to the heart via voltage source 68, transmission leads66 and electrical contacts or electrodes 64. Where balloon 60 must bemaintained in the pericardial space for an extended period, a salinesolution provided with corticosteroids is advantageously delivered tothe intrapericardial space for at least inhibiting the formation ofadhesions.

In assisting a malfunctioning heart with the intrapericaardial assistdevice 100 of FIG. 10, balloon 102 is inserted into an intrapericardialspace about a heart disposed in the space. Subsequently, balloon 102 isinflated in the intrapericardial space to place a compressive pressureon the heart sufficient to force blood from the heart. In addition,lubricant 110 is fed to the intrapericardial space after insertion ofballoon 102 into the space. Lubricant 110 is fed to the intrapericardialspace by dripping the lubricant via gravity flow along feed tube 108.The inserting of balloon 102 into the intrapericardial space isaccomplished via a hypodermic type needle 34 (FIGS. 3 and 4), asdiscussed above with reference to FIGS. 7A-7C. The insertion may beaccomplished under direct vision, where a distal end of an endoscope(not shown) is inserted into the intrapericardial space.

It is to be noted that an intrapericardial assist balloon as describedhereinabove can be used not only where a heart is stopped but also wherethe heart is functioning poorly. For example, where a patient is acandidate for a heart transplant, a cardiac assist balloon as disclosedherein may be implanted into the intrapericardial space for an extendedperiod of time while the patient awaits for a donor heart.

Although the invention has been described in terms of particularembodiments and applications, one of ordinary skill in the art, in lightof this teaching, can generate additional embodiments and modificationswithout departing from the spirit of or exceeding the scope of theclaimed invention. For example, there are alternative methods forinserting a balloon type cardiac assist device into the intrapericardialspace. Such alternative methods include placing the balloon through alaparoscopic cannula inserted either through the rib cage and alongsidethe sternum, or below the rib cage and above the diaphragm. Theinstallation of an intrapericardial assist device may be accomplishednearly under direct vision, through a small incision beneath the ribs,without splitting any ribs.

Accordingly, it is to be understood that the drawings and descriptionsherein are profferred by way of example to facilitate comprehension ofthe invention and should not be construed to limit the scope thereof.

What is claimed is:
 1. A surgical method for aiding a malfunctioningheart, comprising:providing an inflatable balloon in a collapsedconfiguration; inserting said balloon into an intrapericardial spaceabout a heart disposed in said space; inflating said balloon in saidintrapericardial space to place a compressive pressure on the heartsufficient to force blood from the heart; and feeding a lubricant to theintrapericardial space after insertion of said balloon into said space.2. The method defined in claim 1 wherein said the feeding of saidlubricant comprises dripping said lubricant into said intrapericardialspace by a gravity flow.
 3. The method defined in claim 1 wherein saidlubricant is a saline solution with cortico-steroids to at least reduceadhesion formation.
 4. The method defined in claim 1 wherein saidballoon is made of a flexible material and has an external surface witha low coefficient of friction.
 5. The method defined in claim 1 whereina first tube and a second tube are operatively connected to saidballoon, the inflating of said ballooon including guiding a fluid underpressure to said balloon via said first tube, the feeding of saidlubricant to said intrapericardial space comprising guiding saidlubricant to said intrapericardial space via said second tube.
 6. Themethod defined in claim 1 wherein the inserting of said balloon includesinserting a hypodermic type needle through a skin surface and into saidintrapericardial space, and injecting said balloon in said collapsedconfiguration into said intrapericardial space.
 7. The method defined inclaim 6, further comprising the step of deflating said balloon uponcompletion of said step of inflating, also comprising the step of againinflating said balloon upon deflation thereof.
 8. The method defined inclaim 1, further comprising the step of periodically inflating saidballoon upon completion of said step of inserting.
 9. The method definedin claim 1 wherein said balloon is provided with an electrode on asurface adapted for contact with the heart, further comprisingconducting a voltage through the electrode to the heart after inflationof said balloon.
 10. The method defined in claim 9 wherein said voltageis a defibrillating voltage, further comprising the steps of:uponcompletion of said step of conducting, monitoring heart action via anEKG device for a predetermined period; and upon a determination that theheart has started with an inadequate strength, inflating said balloon insynchronism with a heart contraction to place a compressive pressure onthe heart to thereby increase pumping action.
 11. The method defined inclaim 1, further comprising the steps of generating a pacemaker typeperiodic voltage, said step of conducting including the step of applyingsaid periodic voltage to the heart via said electrode; andmaintainingsaid balloon in an inflated state during said step of applying tomaintain said electrode in electrically conductive contact with theheart of the patient.
 12. An intrapericardial assist device comprising;aballoon having a predetermined size and shape in an expandedconfiguration so that said balloon is capable of being disposed in anintrapericardial space about a heart; inflation means operativelyconnected to said balloon for inflating said balloon from an unfoldedcollapsed configuration to the expanded configuration; and lubricatingmeans operatively connected to said balloon for delivering a lubricantto an external surface of said balloon upon disposition of said balloonin the intrapericardial space.
 13. The device defined in claim 12wherein said lubricating means includes a tube extending to a source oflubricating fluid.
 14. The device defined in claim 12, furthercomprising spring means connected to said balloon for automaticallyunfurling said balloon from a folded collapsed configuration to anunfolded collapsed configuration, said spring means being different fromsaid inflation means, said spring means includes an elongate ribelement.
 15. The device defined in claim 12 wherein said inflation meansincludes means for automatically and periodically inflating andalternately deflating said balloon upon a disposition thereof into saidintrapericardial space.
 16. The device defined in claim 12 whereinelectrical contact means are disposed on a surface of said balloon forconducting electrical energy to the heart upon an insertion of saidballoon into the intrapericardial space, also comprising meansoperatively connected to said contact means for supplying electricalenergy to said contact means.
 17. A surgical method for assisting amalfunctioning heart, comprising the steps of:inserting a balloon intoan intrapericardial space; and inflating the balloon in saidintrapericardial space to place a compressive pressure on a heart insaid intrapericardial space sufficient to force blood from the heart.18. The method defined in claim 17, further comprising the step ofperiodically inflating said balloon upon completion of said step ofinserting.
 19. The method defined in claim 17, further comprising thestep of unfolding said balloon in said intrapericardial space uponinsertion of said balloon into said intrapericardial space.
 20. Themethod defined in claim 17 wherein the inserting of said balloonincludes inserting a hypodermic type needle through a skin surface andinto said intrapericardial space, and injecting said balloon in acollapsed configuration into said intrapericardial space.